Department of Epidemiology and Biostatistics, VU University Medical Centre, The EMGO+ Institute for Health and Care Research, Vander Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands,
Eur Spine J. 2014 May;23(5):1021-43. doi: 10.1007/s00586-013-3161-2. Epub 2014 Jan 18.
Assessing the benefits of surgical treatments for sciatica is critical for clinical and policy decision-making. To compare minimally invasive (MI) and conventional microdiscectomy (MD) for patients with sciatica due to lumbar disc herniation.
A systematic review and meta-analysis of controlled clinical trials including patients with sciatica due to lumbar disc herniation. Conventional microdiscectomy was compared separately with: (1) Interlaminar MI discectomy (ILMI vs. MD); (2) Transforaminal MI discectomy (TFMI vs. MD).
Back pain, leg pain, function, improvement, work status, operative time, blood loss, length of hospital stay, complications, reoperations, analgesics and cost outcomes were extracted and risk of bias assessed. Pooled effect estimates were calculated using random effect meta-analysis.
Twenty-nine studies, 16 RCTs and 13 non-randomised studies (n = 4,472), were included. Clinical outcomes were not different between the surgery types. There is low quality evidence that ILMI takes 11 min longer, results in 52 ml less blood loss and reduces mean length of hospital stay by 1.5 days. There were no differences in complications or reoperations. The main limitations were high risk of bias, low number of studies and small sample sizes comparing TF with MD.
There is moderate to low quality evidence of no differences in clinical outcomes between MI surgery and conventional microdiscectomy for patients with sciatica due to lumbar disc herniation. Studies comparing transforaminal MI with conventional surgery with sufficient sample size and methodological robustness are lacking.
评估手术治疗坐骨神经痛的益处对于临床和政策决策至关重要。本研究旨在比较微创（MI）和传统显微椎间盘切除术（MD）治疗腰椎间盘突出症所致坐骨神经痛患者的效果。
对包括腰椎间盘突出症所致坐骨神经痛患者的对照临床试验进行系统评价和荟萃分析。单独比较传统显微椎间盘切除术与：（1）椎板间 MI 椎间盘切除术（ILMI 与 MD）；（2）经椎间孔 MI 椎间盘切除术（TFMI 与 MD）。
提取腰痛、腿痛、功能、改善、工作状态、手术时间、出血量、住院时间、并发症、再次手术、镇痛药和成本结局数据，并评估偏倚风险。使用随机效应荟萃分析计算汇总效应估计值。
共纳入 29 项研究，其中 16 项 RCT 和 13 项非随机研究（n=4472）。手术类型之间的临床结局无差异。有低质量证据表明，ILMI 手术时间延长 11 分钟，出血量减少 52ml，平均住院时间缩短 1.5 天。并发症或再次手术无差异。主要局限性是偏倚风险高、研究数量少以及比较 TF 与 MD 的样本量小。
对于腰椎间盘突出症所致坐骨神经痛患者，MI 手术与传统显微椎间盘切除术的临床结局无差异，证据质量为中到低。缺乏足够样本量和方法学稳健性的比较经椎间孔 MI 与传统手术的研究。
